Tennessee medical groups urge expansion of Medicaid

LOS ANGELES, CA - SEPTEMBER 27: Dental work is performed as part of a free health care service at the Care Harbor clinic at the Los Angeles Sports Arena on September 27, 2012 in Los Angeles, California. Care Harbor is expected to give free medical, dental and vision care to 4,800 uninsured patients at the event, which runs from September 27-30. In Los Angeles County it is reported that 2.2 million people do not have health insurance, which includes an estimated 227,000 young and school-aged children. (Photo by Kevork Djansezian/Getty Images)(Photo: Kevork Djansezian Getty Images)

The associations representing the state's doctors and nurses are jointly calling for Gov. Bill Haslam and the legislature to expand TennCare, the Medicaid program in Tennessee.

Dr. Chris Young, president of the Tennessee Medical Association, and Jill Kinch, immediate past president of the Tennessee Nurses Association make an economic argument for expansion. They are asking state leaders to make pragmatic decisions until future elections determine the final fate of the Affordable Care Act. The repercussions of not expanding Medicaid will affect Tennesseans of all incomes, they said.

"What we are really looking at are all the elements of an impending health care crisis," Young said.

The law is ending subsidies for hospitals across the state, including ones in rural counties, that treat large proportions of uninsured patients because the federal government will instead pick up the cost of expanding Medicaid. Other revenue streams for health care providers are simultaneously dwindling, putting hospitals in financial straits that will lead to closures and downsizing as well as doctors and nurses leaving Tennessee for other states, they said.

"I know that Medicaid expansion is a very controversial topic," Kinch said. "We're not saying this is the solution for the next 10 years, but we need answers and we need solutions for the next couple of years so that we can get through. The access-to-care issue is going to come to a crisis."

The federal government will pick up 100 percent of the costs of insuring new people brought onto state Medicaid rolls through 2016, as provided by the Affordable Care Act. It will then phase down to a permanent 90 percent matching rate in 2020.

Many Tennesseans are already paying higher federal taxes to fund Medicaid expansion and other components of the law.

"We need to keep those Tennessee tax dollars in our state," Kinch said. "If we don't expand Medicaid, those dollars are just going to other states that are opting for Medicaid expansion."

Looming crisis

Although doctors and nurses see patients dying of diseases that could have been prevented if treated earlier, Kinch and Young decided to focus on health care economics because they said it is a looming crisis in Tennessee that has been largely ignored.

"There is a reason why hospitals exist in counties," Young said. "People want a place to go to when they need hospital care. It is a burden to travel 100 miles to have a person in the hospital."

Kinch described the scenario of subsidies ending and revenues dwindling as a perfect storm without Medicaid expansion. The political battles over the law can wait until the next election, the two said, because practical, economic decisions are needed now.

"We have gone through the controversy over the Affordable Care Act and its passage," Young said. "We've gone through an election. We've gone through a Supreme Court decision. We've gone through a government shutdown. I think in some people's minds they thought this was all just going to go away," Young said. "The fact is the Affordable Care Act is the law. We are going to have to learn how to manage within the law for the foreseeable future — at least to the next presidential election."